Incremental Utility of First-Pass Perfusion CMR for Prognostic Risk Stratification of Cancer-Associated Cardiac Masses

doi:10.1016/j.jcmg.2023.05.007

Cardio-oncology & otherCohort study

Incremental Utility of First-Pass Perfusion Cardiac Magnetic Resonance (CMR) for Prognostic Risk Stratification of Cancer-Associated Cardiac Masses

JACC Cardiovasc ImagingPublished 5 Jul 2023

Matched cohort study
matched for cancer type/stage

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Authors' conclusion

Perfusion CMR yields prognostic utility that complements LGE-CMR: Among cancer patients with LGE-CMR defined CMET, mortality increases in proportion to magnitude of lesion hypoperfusion.

Study context

Population: Adult cancer patients with cardiac masses on CMR and matched controls without
Participants: 462 patients

Exposure: Perfusion CMR vs LGE-CMR for cancer-associated cardiac masses
Cardiac metastasis (CMET)n = 173
Cardiac thrombus (CTHR)n = 69
Outcome: All-cause mortality

Main finding

As reported in the abstract

All-cause mortality, CMET vs controls

CMET vs CMASS-Hazard ratio (95% CI)P value

semiquantitative perfusion CMR-evidenced CMET

1.42(1.06–1.90)

P = 0.02

visual perfusion CMR

1.47(1.12–1.94)

P = 0.006

LGE-CMR

1.52(1.16–2.00)

P = 0.003

Among CMET on LGE-CMR, mortality highest with lesions in bottom contrast enhancement ratio (CER) tertile (low vascularity): P = 0.002
CMET vs matched controls, upper CER tertile: mortality equivalent: P = NS
CMET vs matched controls, middle CER tertile: increased mortality: P = 0.03
CMET vs matched controls, lowest CER tertile: increased mortality: P = 0.001

Observational data: associations, not effects.

Further findings

Differentiation of CMET vs CTHR by perfusion CMR — CER and contrast uptake rate (CUR) higher within CMET vs CTHR: P < 0.001
Differentiation of CMET vs CTHR by perfusion CMR — CUR better than CER: P < 0.001
Survival in CMET · 1 year post-CMR: 47%

Differentiation of CMET vs CTHR by perfusion CMR: CUR AUC 0.89-0.93
Differentiation of CMET vs CTHR by perfusion CMR: CER AUC 0.66-0.72

Differentiation of CMET vs CTHR by perfusion CMR

Both typically misclassified CMET with minimal enhancement (CUR P = 0.10; CER P = 0.01)

Original publication

Incremental Utility of First-Pass Perfusion CMR for Prognostic Risk Stratification of Cancer-Associated Cardiac Masses. JACC Cardiovasc Imaging. Published 5 July 2023. doi:10.1016/j.jcmg.2023.05.007

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Summarised from the published abstract; every number is checked against it